Helpful Forms

If you are a new client, please complete the following forms and bring them to your first session. The Services Agreement will also provide you with more information about my practice.

Psychotherapy Forms:

To be completed by new clients requesting evaluation and/or therapy services.

• Registration Packet - Children & Adolescents

• Agreement if Parents are Separated/Divorced (needed prior to the start of treatment)
• Registration Packet - Adults (18 and older)
• Fee Schedule
• Notice of Policies and Practices to Protect the Privacy of Your Health Information
• Background History Form

Co-Parenting/Collaborative Law/Mediation /Reunification Forms:

• Registration Packet
• Background Information Form

***If you are coming in for collaborative law services or mediation services, additional paperwork maybe completed during our session.

Release of Information

If you would like me to coordinate care with another provider (for example, your child's pediatrician, psychiatrist, teacher, etc.), please complete this form:

• Consent to Release Information Form

Telehealth

If you are interested in using Teleheath (video conferencing) for sessions, I will email you forms and the link to the virtual waiting room for our sessions.